Chemotherapy is a treatment used for some types of cancer. This section gives information about chemotherapy. We hope that it answers some of the questions you may have about the treatment and helps you to cope with any side effects it may cause. Where cancer is mentioned, this refers to cancer, leukaemia and lymphoma.
Sometimes chemotherapy is used to treat non-cancerous conditions but often the doses are lower and the side effects may be reduced.
Sometimes chemotherapy is used to treat non-cancerous conditions but often the doses are lower and the side effects may be reduced.
<!--[if !supportLists]-->1. Therapeutic : acute lymphatic leukaemia ( ALL ), hodgkins disease ( HD ), corio carcinoma an testicular tumor.
<!--[if !supportLists]-->2.Palliative : to reduce the pressure symptoms of tumors on vital organs, lungs, osephagus,tracea, nerves etc. And reducing the size of the tumors.
<!--[if !supportLists]-->3. Adjuvat : in combination with surgery and radiotherapy to eliminate any micro metastasis. Eg cancer of the breast, bone sarcoma and soft tissue sarcoma.
<!--[if !supportLists]-->4. Neoadjuvant : 2 – 3 course of chemotherapy is given before radiation or surgery.
General Principles Of Chemotherapy :
<!--[if !supportLists]-->1. To destroy or remove all neoplastic cells with minimal effects on normal host cells tissue.
<!--[if !supportLists]-->2. Drug with different modes of actions and side effect are combined then the effect on the tumor can be increasing the severity of the side effects.
<!--[if !supportLists]-->3. Chemotherapy can more effective in patient who may be at a risk of distant micro metastasis after effective treatment with radiotherapy and / or surgery. Chemotherapy offer systemic control of the disease, where as surgery and radiotherapy offer local control only.
<!--[if !supportLists]-->4. Chemotherapy can also be combined with immunotherapy or hormone therapy to be more effective.
<!--[if !supportLists]-->5. Chemotherapy is contraindicated in existing bone marrow depression with low white cell count and platelet count. Presence of severe infections, impaired renal or hepatic dysfunctions.
<!--[if !supportLists]-->6. Chemotherapy is administered in 5 – 6 course at an interval of 3 – 4 weeks depending upon the disease and regimen being followed.
<!--[if !supportLists]-->7. Side effect of chemotherapy are usually not life threatening but in case of toxic effect such as nephrotoxicity, severe bone marrow depression or anemia they may have to reduce the medications dose, postpone or discontinue the treatment.
<!--[if !supportLists]-->8. The dose administered must be the maximum dose that can be tolerated by the patient.
<!--[if !supportLists]-->9. Certain malignancy exhibits resistance to chemotherapeutic drugs. Resistance may be from the star treatment or after the treatment has begun.
<!--[if !supportLists]-->A. CYTOSTATIC
1. Alkalyting agent : Nitrogen mustard, chlorambucil, cyclophospamide, ifosfamde, BCNU, CCNU, DTIC, temodal, cisplatin, carboplatin, oxaliplatin
2.Antimetabolite : Methrotaxe, cytarabine, capetabine ( xeloda ), 5 flourouracil
3. Natural Product :
a. Inhibitors : vinblastine, vincristine, vinoralbine (navelbine), paclicatel (taxol), docetaxel (taxotere)
b. Topoismerase Inhibitors : etoposide (vp16), tenoposide, irinotecan (campto, CPT 11), topotecan (ycamtin)
c. ANtibiotic : bleomycine, doxorubicyne, caelyx, daunorucine, noantrone, mitomicyn, epirubicin
d. Enzym : asparaginase
B. HORMONAL ANTINEOPLASTIC AGENTS
1. Corticosteroid : dexamethasone, prednisolone, hydrocortisone, methylprednisolone, prednisolone
2. Progestins : megestrol acetate (megace), medroxyprogesteron acetate (provera)
3. Estrogen antagonist : tamoxifen (nolvade)
4. Androgen antagonist : flutamide, nilutamide
5. Aromatase inhibitors : anastrozole (arimidex), letrozole (femara), exemestane ( aromasin)
6. Luteinizing hormone-releasing hormone anatagonis : goserelin (zoladex), leuprolide ( lupron)
C. BIOLOGIC RESPONE MODIFIERS (IMMUNOTHERAPY)
1. Interferons : Interferons alpha (roferon, intron, wellferon), interferon beta, gamma -rarely used
2. interluekin-2 : proleukin
D.BILOGICAL TARGETED AGENTS
herceptine, mabthera, gleevec, iressa, erbitux, avastine, velcade, myltorag
1. Alkalyting agent : Nitrogen mustard, chlorambucil, cyclophospamide, ifosfamde, BCNU, CCNU, DTIC, temodal, cisplatin, carboplatin, oxaliplatin
2.Antimetabolite : Methrotaxe, cytarabine, capetabine ( xeloda ), 5 flourouracil
3. Natural Product :
a. Inhibitors : vinblastine, vincristine, vinoralbine (navelbine), paclicatel (taxol), docetaxel (taxotere)
b. Topoismerase Inhibitors : etoposide (vp16), tenoposide, irinotecan (campto, CPT 11), topotecan (ycamtin)
c. ANtibiotic : bleomycine, doxorubicyne, caelyx, daunorucine, noantrone, mitomicyn, epirubicin
d. Enzym : asparaginase
B. HORMONAL ANTINEOPLASTIC AGENTS
1. Corticosteroid : dexamethasone, prednisolone, hydrocortisone, methylprednisolone, prednisolone
2. Progestins : megestrol acetate (megace), medroxyprogesteron acetate (provera)
3. Estrogen antagonist : tamoxifen (nolvade)
4. Androgen antagonist : flutamide, nilutamide
5. Aromatase inhibitors : anastrozole (arimidex), letrozole (femara), exemestane ( aromasin)
6. Luteinizing hormone-releasing hormone anatagonis : goserelin (zoladex), leuprolide ( lupron)
C. BIOLOGIC RESPONE MODIFIERS (IMMUNOTHERAPY)
1. Interferons : Interferons alpha (roferon, intron, wellferon), interferon beta, gamma -rarely used
2. interluekin-2 : proleukin
D.BILOGICAL TARGETED AGENTS
herceptine, mabthera, gleevec, iressa, erbitux, avastine, velcade, myltorag
Mechanisms of chemotherapy action
Chemotherapy drugs are effective in destroying cancer cells because they interfere directly or indirectly in with the synthesis or functions of nucleic acids. Chemotherapy also produce undesirable damage to the rapidly growing normal cells of the body such as hematologic suppression. Gastrointestinal tract lining inflammation and scalp hair loss. The highly fatal nature of the disease makes the risk of serious toxicity relatively acceptable.
CELL CYCLE :
a review of cell cycle to understand the mechanism of chemotherapeutic action
<!--[if !supportLists]-->a. G1 ( gap one ) phase : 18 hours post mitotic enzymes for DNA synthetic are manufactured.
<!--[if !supportLists]-->b. S ( synthesis ) phase : 20 hours synthesis of DNA takes place. The chromosome content of DNA doubles.
<!--[if !supportLists]-->c. G2 ( gap two ) phase : 3 hours synthesis of RNA and format ion of mitotic spindle shapes.
<!--[if !supportLists]-->d. M ( mitosis ) phase : 3 hours – the cell divides into two daughter cells which enter into G0 or G1 phase of the cell cycle.
<!--[if !supportLists]-->e. G0 (gap zero ) phase : the inactive resting phase of the cell cycle.
Cell cycle specific drugs interrupt the cell cycle at one or more specific phase eg. Plant alkaloids and anti metabolites. Cell cycle nonspecific may act at all phase of the cell cycle eg. aNtibiotics and alkalyting agents.
Anti-Neoplastic Agent Administration, Handling & Disposal
INTRODUCTION:
Cancer chemotherapy drugs can cause mutagenesis, teratogenesis, carcinogenesis, and sterility when administered to humans. The risk varies with the specific drug and its concentration, and with the frequency and duration of exposure.
Concern has therefore been raised regarding potential hazards to personnel handling chemotherapy. Studies indicate that observing certain precautions while handling chemotherapy reduces personnel exposure and presumably risk.
All personnel working with chemotherapeutic agents must read the agent’s Material Safety Data Sheet (MSDS) to address the requirement for hazard awareness training.
PRECAUTIONS FOR AGENT PREPARATION (reconstitution and dilution):
1. All agent preparation must be performed in a ducted biosafety cabinet.
2. Wear chemotherapy gloves or double gloves of either surgical quality latex gloves or nitrile. Chemotherapy gloves provide the greatest protection.
3. Wear a protective gown that is lint-free, non-permeable with a solid front, long sleeves, and tight-fitting elastic or knit cuffs (gowns specifically designed for chemotherapeutic agents).
4. When double gloving, one glove should be placed under the gown cuff and one over.
5. The outer glove should be changed immediately if contaminated. Both gloves should be changed if the outer gloves is torn, punctured, or overtly contaminated with the drug (as in a spill) and every hour during preparation.
6. All potentially contaminated disposable items (gloves used in prep) must be placed in a plastic bag (while in the biosafety cabinet) and then in the chemotherapy waste container. Sharps should be disposed of in a sharps container specific for chemotherapy. This sharp container must be labeled as holding chemotherapy items.
7. Preparations should be performed over plastic backed absorbent pads. Dispose of as noted above, immediately upon contamination.
8. External surfaces of syringes should be wiped with a clean alcohol pad to remove any potential contamination.
9. Chemotherapeutic agents must be stored in an area labeled chemotherapeutic agents.
10. Chemotherapeutic agents must be transported in ziplock bags with chemo labels.
11. Leurlock syringes are recommended.
12. A Chemotherapeutic agent spill kit must be available. 70% isopropyl alcohol is an acceptable decontaminant for these agents.
13. The ducted biosafety cabinet should be cleaned (70% isopropyl alcohol) upon completion of tasks.
14. Hands must be washed upon completion of tasks.
15. Excess chemotherapeutic agent, not used, must be disposed of in chemotherapy waste container.
PRECAUTION FOR AGENT ADMINISTRATION:
Wear double gloves (latex or nitrile) for all procedures involving chemotherapy administration.
- Change gloves after each use, tear, puncture, medication spill, or after 30 minutes of wear for latex, 60 minutes for nitrile.
- Wear protective gown with solid front at all time.
- For situations where potential eye contact with chemotherapeutic agent exists, safety goggle or face shield should be used.
- Use leurlock needles, if possible.
- Dispose all waste material in the appropriate chemical waste container.
CHEMOTHERAPY WASTE COLLECTION AND DISPOSAL:
1. Dispose all waste in a plastic bag and discarded in the chemical waste container
2. Seal filled chemical waste containers with the enclosed screw top
CLEANING CHEMOTHERAPY SPILLS
- Spills must be cleaned up immediately by properly protected trained personnel. Spills should be cleaned using contents in the spill kits. All other persons should leave the area.
- Small spills (less than 5 ml) outside the BSC should be cleaned immediately by personnel wearing a gown, two pairs of gloves (latex or nitrile) and mask. For spills greater than 5ml, a respirator mask (requires enrollment in UW’s respirator program) and eye protection should also be worn (found in the spill kits).
- Liquids should be wiped with absorbent pads. The spill area should then be cleaned thoroughly with a detergent solution followed by clean water. Place waste in plastic bag and then in the chemotherapy waste container.
ACUTE EXPOSURE OF SPILLS
1. In case of skin contact with an antineoplastic drug product, wash the affected area as soon as possible. Report incident to supervisor, complete Accident/Injury Report.
- For eye exposure, flush with water for ~15 minutes.
